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General NPI Number Information
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NPI Number | 1033381140
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Entity Type | Organization
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Legal Business Name | GURNEE RADIOLOGY CENTER, LLC
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1800 HOLLISTER DR SUITE G-10
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5263
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Country | US
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Telephone | 847-968-5300
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Fax | 847-968-2400
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Provider Business Mailing Address
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Address Line | 25 TOWER CT SUITE A
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City | GURNEE
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State | IL
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Zip | 60031-3318
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Country | US
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Telephone | 847-249-3700
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Fax | 847-249-4880
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY LEE ROSENGARTEN
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Credential | MD
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Telephone | 847-249-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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